[0:00] - Welcome, my name's Dr. Oreck Bishop. I'm a cardiologist, an author, and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people [0:12] Live as well as possible. [0:13] for as long as possible. [0:15] Heart disease is huge in Australia. [0:18] Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. [0:26] This podcast is all about helping you understand blood pressure, weight, cholesterol and [0:32] for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save [0:41] Someone you love. [0:42] Welcome, it's Dr. Warrick here and thank you so much for joining me today. I'm actually really pleased to share a guest [0:52] Today with you who's reached out to me directly and this is about something I genuinely don't know much about with me today is Jack Clifford. So before we launch into that Jack, I'd like to thank you and appreciate you for reaching out and sharing today. But for those listening, Jack is a 52 year old male. His history professionally is that he worked in the military and then in his late 40s. [1:21] developed chest problems and in fact in at 47 years of age during COVID in 2022 had a heart attack and that really I think kicked off a journey for Jack along a particular technology that we'll be talking about today and I'm [1:40] really, I'm really grateful to have the chance to [1:44] Share with someone who's intimately involved with this and learn more about it. I hope you get lots out of it. Jack from Florida. Thank you so much for joining me. [1:53] Sure thing. My pleasure. It's great to be here, Dr. Ork. Appreciate it. Jack, look, I've quickly alluded to your medical history, but just in a very tight couple of words, a quick summary of where you were. I imagine if you were in the military, you were a reasonably fit fellow. And then 2022, talk me a little bit around that in the executive summaries of the style. [2:23] the essence of what we want to talk about today. [2:27] Sounds good. Yeah, it was actually 2020 when this started. So December of 2020, ended up, the quick version is I ended up with 100% blocked LAD, so the little maker for your audience, I'm sure, they're mostly familiar. Left anterior descending artery. So three coronary arteries were blocked, unstintably blocked. Recommendation was emergency bypass surgery. Not something I was [2:57] alternative, EECP, Enhanced External Counterpulsation, which is a machine that perhaps we can talk about here in a minute that uses compression to prompt your body slowly over time to grow its own bypasses. And that's what I did. [3:15] So this is... [3:17] So this is a great start here, Jack. So really, for those listening, there's a couple of bits and pieces that came out quickly. So let me... [3:26] Just make sure we get those all clear. [3:30] Jack can really bad coronary arteries. And then he's referred to a piece of technology called EECP, which stands for it's... [3:42] What did you say? External? Enhanced external counterpoltation. Enhanced external counterpoltation. [3:49] Counter pulsation. Enhanced... [3:53] external counterpulsation. How did you come across that technology, Jack? How did that come out? Yeah, only... [3:59] I was only loosely aware of its existence because I had heard a podcast mentioning it in 2015. My mom had undergone bypass surgery, and it was really traumatic for her brain. She never really recovered her cognitive function after that. So I was just aware of it, but I knew the risk factors I had genetically. [4:19] Um, [4:20] But access was a huge problem. There aren't many providers. And so I just knew about it in the hospital. That's it. I had the weekend to think about it. They were going to do the heart cath, which was going to go to bypass on Monday. [4:35] I had the weekend to think about it. I started really looking into anything and everything, including AECP, and just decided I was going to give that a shot. [4:43] Okay. So, the... [4:46] In a very quick summary, again, just you're a young person, [4:51] bad coronary arteries, told you needed surgery, looking for alternates. You heard of something called enhanced external counterpulsation, [5:01] And we're going to talk about that in a second. But you wanted to explore some options before going down that bypass route, mainly because of concerns that you'd seen through your mother's own journey, particularly with dementia and cognitive function. And that makes perfect sense. And I think if there's anything that I'm really trying to do when it comes to sharing podcasts and information like this, it's just improving people's health literacy so they maybe have a better understanding of what's available. [5:31] what they might be able to do, and what questions they might be able to ask. So thank you. With that as a backdrop, Jack, can you never tell these good people listening or watching, what is it? What does EECP actually do? External enhanced, enhanced external counterpulsation. What does it actually mean? What does it do? [5:53] So fascinating. Okay, so there's certainly plenty of videos. If any of your listeners or watchers want to just hop on YouTube and put in ADCP, you'll see plenty of videos of the machine at work. But you're lying on a bed. [6:08] And you get strapped in with cuffs around your legs, three of them on each side, so in your calves, your thighs, and your hips. [6:19] And you get hooked up to an EKG, a three-lead EKG. [6:25] So three, one, two, three. And then the machine does compression in between heartbeats. So when your heart's at rest at diastole, the machine is pushing blood from your lower legs up through your hips up into your upper body. [6:55] It helps feed your heart in between heartbeats. And the really super fascinating thing that I found over time, because I have around 700 hours on EECP, which honestly might be the most hours of any person alive. I don't know. Certainly never heard of anyone with that many hours. [7:13] It's... [7:14] It's, you know, it's... [7:15] It's an iterative process. It functions a lot like just cardiovascular exercise while you're lying on a bed. [7:21] Although I like to say it's at supra-physiologic levels, meaning levels that human beings couldn't really perform on their own, regardless of how fit they were. Um... [7:30] But, you know, it's a growth stimulus. You know, your body releases massive amounts of VEGF, this vascular and mithrilineal growth factor. It's very well researched and documented to release thematic hoietic stem cells. [7:48] And, you know, to be honest with you, it might be the most well-researched medical device on the planet. I'm not saying that it is, but if it isn't, it's a contender. So the fact that people haven't heard about it is really strange to me when that's the case. And yet the common thing is EECP what? [8:06] It doesn't matter if you're talking to a doctor. [8:10] Absolutely. [8:10] It's just, it's ubiquitous. And, you know, again, I don't know what the access situation is in Australia, but here in the United States, it's abysmal. [8:18] Thank you. [8:19] The machine is used a lot of different ways in other countries. So in India and China, you'll find a lot more providers, a lot more access, a lot more use cases. But the thing, Work, I really want you to know and I want your listeners to know is that [8:33] it's useful for things way beyond just its cardiac implications. It works amazingly for erectile dysfunction. It works really well for kidney perfusion. It could potentially keep somebody off of dialysis if they were, you know, [8:47] Heading down there. [8:49] It works really well for dementia. It was studied in 2023 by Dr. Moriarty, a cardiologist at the Kansas University Medical Center. And the results, and this is a very well-designed, 100% study. [9:03] person plus participants with a sham arm. [9:07] Basically, reverses dimensions. [9:10] Dementia should be getting worse. People that got EECP got better. Some of them dramatically better, but all of them improved. It's just a small example. I mean, it's blood flow. [9:20] Thank you. [9:21] So if I can tease out some of this, Jack, and you may, it doesn't matter if you know the answers or not, but as I'm thinking about it and as the people tuned in, [9:30] either listening or watching or thinking about it, then we think of the heart squeezing, that's systole, that's the squeezing component of the cardiac cycle. [9:42] contracting component of the cardiac cycle and the blood pressure goes up. [9:47] Now, [9:48] That obviously drives perfusion, but the significance of that is, [9:55] for the heart is that [9:57] the heart's squeezing at the same pressure that the... [10:02] blood pressure is just above the heart because it's the muscle of the heart with the blood vessels around it. [10:10] that I... [10:12] part of the force that are generated. So there's an equal force through there, which for those listening means that blood flow during systole... [10:23] doesn't really happen that effectively, at least for the heart. We're going to talk about other organs in a minute. But if you think about it, [10:32] If the heart's squeezing at 100 millimetres of mercury and the pressure in the aorta is 100 millimetres of mercury, there's no gradient. And so during that time of squeeze, the... [10:43] the blood won't necessarily flow into the ventricle. This means that when you relax and the heart goes into that relaxation phase, the phase we call relaxation, [10:53] diastole [10:55] all the phase that we measure the lower blood pressure on for those who are interested in blood pressure. [11:01] that that's the time predominantly when blood flows. So my immediate response, [11:08] thought about this is that if you are... [11:14] apply [11:15] a squeeze, a counter pulsation during diastole, during the time that the heart's resting, your first thing that you'll have a dramatic effect on is blood flow to the coronary arteries, [11:29] during the rest phase. So I imagine that's what it shows. But what you're talking about, Jack, it changes even beyond that. Do you want to speak to that just a little bit? Of course. [11:38] So, so much. And, you know, again, it's a matter of hours. The interesting thing is, so while I said it's one of the most, if not the most well-researched medical device on the planet, it's sort of arbitrarily researched at this 35-hour protocol. [11:53] which, you know, you get significant benefits at 35 hours. Lots of the studies, they all show that. [12:00] But that's pretty arbitrary. The study designs, I'm sure, had to do with patient access and the amount of time you could reasonably think somebody could go somewhere and do something. 35 hours is still a lot of time, right? Yeah. A lot of time for the doctor. But... [12:19] uh, [12:19] If you go beyond 35 hours, you go to double that, triple that, quadruple that. [12:25] Or is it magnitude above that other things happen? [12:28] I'm living proof of that. For me, a small little example, I could [12:35] I don't get up to pee at night. I'm 52. Uh, I can, my bladder can hold insane amounts of whatever I need. I produce urine at a rate that's, you know, I mean, it's graphic TMI stuff here, but, but the point is, you know, my kidneys are functioning like champs. Um, and, uh, [12:54] That's just one organ system. I'm sure you know and your listeners know your cardiovascular system is an interconnected web of 60,000 miles of blood vessels. [13:08] So let me... [13:09] So I think there's obviously going to be better blood flow during diastole. That's a really fascinating component. You also talked about some of the cellular messengers like vascular growth factors. [13:24] that potentially could arise right through the body. Do you want to speak to that research a tiny bit, Jack? And for those listening, vascular growth factors mean that the cells within an area of the body are really sending messages from [13:41] to the immediate surround to create new blood vessels, to improve blood flow, to grow and respond to external stimuli. Yeah. Yeah. [13:55] So I don't know that I have any documentation to back this up, but the way I like to think about it is that wherever there's pressure differentials within your vascular system, i.e. the machine is sending all this massive amount of blood upstream, right, up your body, it's telling the pipes, hey, this is what you have to accommodate. And they're stretching through this thing. I'm sure you're familiar with Dr. Wark, you know, sheer stress, right, which is what we get when we exercise. [14:25] stress on those walls that's forcing them to respond. Yeah, right. So, [14:30] I like to say, you know, wherever there's pressure differentials, meaning the pipes aren't big enough for what's trying to be sent through in a given moment, then that's the signal. You know, that's what's releasing these growth signals. And then, you know, I don't know that this is... [14:44] It's not exactly literally true, but you can see where different channels are being created. I'll show you just a small demonstration here because I think you can see it. Can you see this big temple vein I have? [14:56] I can say about it, yeah. [14:59] Yeah, I have them on both sides. I didn't have those a couple years ago. I've got these, you know, I've got my vascularity, [15:07] if given the right light, is pretty distinct to me. Right? Like, I've grown... [15:14] vasculature throughout my body. [15:17] like considerable amounts, which sort of speaks to what we're talking about. So let's, so let's come back to you because it's a great, [15:24] I was in fact going to do that, but this is a great opportunity to do so, Jack. When we think about you in 2000, which is what, five, six odd years ago, [15:33] lining up for open-heart surgery, coronary artery bypass grafting. What's been... [15:41] the follow-up in terms of further investigations and assessment of those arteries and what have your cardiologists found to be the impact of the EECP intervening? [15:54] Yeah, so I followed cardiac care through probably about the last two years ago, and then I stopped. I didn't have any follow-up imaging. I tried to get a stress test at the same hospital that [16:09] you know, had me inpatient and they wouldn't, they wouldn't, they literally said you haven't had a stint. You haven't had bypass. You can't do this. And I was actually after they gave me all the nuclear imaging and sat me in the machine. And then I was going to get on the treadmill and they're like, you can't do that. Same doctor who had seen how bad my original stress test was. He literally said it was one of the worst he'd ever seen. Um, [16:31] So I haven't had any follow-up imaging. I do think I may do that on the sooner side, but I can run a sub-seven mile. So a guy with three blocked arteries, and these are still blocked. I just have lots of little routes all around him. The little ones are massive in number and make up for the volume difference. So I can do things now that I couldn't do at any point in my life. [17:00] Do you know that for sure that you've had those extra new blood vessels crowded, Jack, or is that your interpretation of what's gone on after the EECP? Have you had a follow-up angiogram or something to actually demonstrate that? [17:16] I haven't had that as of yet. [17:17] Definitely considering getting it. But, you know, again, I had that trip to the hospital where I did all that work and got radiated and whatnot. It left a bit of a bad taste in my mouth. So I may do that at some point. I'm quite confident of how it would go because, again, you know, I was getting chest pain at like 2.2 miles an hour. [17:36] Yeah. Or I can run eight, nine miles an hour. No problem. So. For those listening and wondering what we're talking about, uh, [17:45] Jack had multiple blockages within his coronary arteries. What can happen is that the body can naturally form new blood vessels and connect areas where there's blood flow with areas where there's not blood flow. This can happen in the heart, but it normally takes time because if you have a heart attack and a sudden block, those new connections just don't have time to form. [18:15] called collaterals. They are called collaterals and they really form a network of supply of blood that's not down the main artery. So if you think of a city or a town and you think of a main highway leading in or out of that town as a way to get cars from one city to another, in this situation what we're talking about is all the little roads where people live on, [18:45] network and them being so prolific that you could drive from one town to the next town on all the little roads. And... [18:54] You do that because the main highway is blocked. We call those collaterals and that's what... [19:00] Jack is alluding to. Now this occurs naturally actually. And in fact just yesterday while I was consulting. I saw a guy who had a 100% blocked circumflex artery. And had produced collaterals. So this is nothing new. [19:19] But EECP, from what I think Jack's experiences and what his observations are, can drive this process and maximize this process and give the body the chance to really do what it's able to do with as much support as possible. And if you think about it, it makes a bit of sense because we're creating a higher pressure environment during that diastolic phase. [19:45] and therefore creating those triggers for growth that Jack was talking about before. Would that sort of summarise where your thoughts are? [19:53] And you stole that roads analogy right from my book. [19:58] Not saying you... No, I'm sorry. Sorry, I didn't. [20:02] In my book, I describe the roads and highways analogy. So, you know, these major arteries that are blocked for me are these freeways, right? Like you said. All these little roads that have... It was just a very wonderful way to explain it. It works. You can see it visually. Look, um... [20:22] We've got only a couple of minutes left. It's been absolutely fantastic speaking with you. [20:29] What... [20:31] What I think we might do to wrap up, you touched on a couple of other things. [20:37] Erectal dysfunction [20:39] chronic renal failure, dementia, just touch on those a bit. And then let's talk about access and then we'll wrap it up. How does that sound, Jack? Great. Yeah. Yeah. Yeah. Yeah. So, um, you know, in the U S the FDA approved indication is for class three and four angina and for heart failure. It's also approved for general circulation in a just non non-specific way. Um, [21:04] But, [21:04] It's studied, really well studied, some in the U.S., a lot of it's overseas. [21:11] for dementia, for erectile dysfunction, for stroke recovery, for stroke prevention, for dementia, [21:20] Even for retinal, improving blood flow to your eyes, I'm sure I'm missing a few, but the indications are really wide and broad. [21:35] you know, my experience, certainly [21:37] I'll just tell you one thing that, you know, like, [21:39] I used to be the late guy at work. If you had the flex hours, I was always the guy rolling in at 9 o'clock in the morning to work because I needed eight, nine hours of sleep, and I was generally running pretty tired. [21:53] I get about four hours of sleep at night now and I'm, [21:56] refreshed, woken up. I track my sleep on an aura ring. I get a very, very healthy amount of sleep, good quality sleep. Generally get up about two, three in the morning. Um, [22:08] Just naturally, because five years ago, that was not me. That's the impact on my brain, among other things. I'd like to think I'm thinking clear and operating at a higher level than I was. That's subjective, but... [22:26] you know, it's, [22:27] I mean, I don't know, don't want to get overly graphic on the erectile dysfunction stuff, but let's just say, yeah, I definitely had it. It was profound. [22:35] it's the opposite of that, if anything, at this point. And, uh, you know, that's, that's quite wonderful. But, um, [22:42] Yeah, there's so many different really, really, really amazing and wonderful things. It's just – it's like exercise. It's gradual. It doesn't happen overnight, and it might be that whatever your goals are, 35 hours is not enough. You know, so there's a lot of different – it really should be goal-driven, I believe, you know, with a provider talking about what the goals are. [23:04] So, I mean, this is absolutely fascinating. Really appreciate you sharing. And I'm sure there are people listening who are learning such a lot about this. But obviously, as you're talking, I've got lots of questions rolling through. One of the things that I'm inclined to ask is, is this something that people would do? [23:24] once a week or twice a week as a healthy aging program. Is that something that you would imagine? Or is it really, do you think you see its role as primarily therapeutic? [23:35] You know, that's an interesting debate. I've tried to push that conversation along in the U.S. and with the manufacturers, to be honest with you, but I'll tell you what, there's quite a few famous people, names I won't name, who own these machines and I think use them to great effect. [23:54] But... [23:55] You know, the interval, I think it's got to go back to the goals. I use it every day still because I like it. It's very soothing when, you know, the machine's pulsing to the beat of my own heart. I can practice breath work. I can really relax and just, you know, have some good peaceful session in the morning before I start my day. Um, [24:15] It's not painful. It's not uncomfortable in any way. You get to the higher pressures, you know, your body does adapt. So there's an adjustment period at some of the pressures, but also the pressures are infinitely adjustable. So, you know, it starts at low pressure, which is about one pound per square inch. And then it goes up. [24:35] to six psi pound per square inch and uh you know it goes up at 0.01 intervals all the way up so you can you can just tap that button and and keep it where you want so it could be that to answer your question that's a long-winded answer sorry but the the you know you could you could certainly get great effect from some regular interval but you know hopping on the machine once you might not notice a difference you know you hop on it twice you still might not notice a difference you you [25:05] A couple of quick ones as we wind up. It sounds like you've got your own machine, so you've got a little. Is that very uncommon or do we normally think that people... [25:20] you need a medical person to administer this would do you need it what sort of training do you do it's a class two medical device so you have to use it in concert with your provider i actually you know i went to a clinic well that was my original challenge i had to drive three hours and stay in a hotel to get my sessions and you know like i couldn't do that forever and i didn't know how many hours i was going to need so i found out to get a machine um [25:45] And, uh, [25:47] The question of whether you can get your own machine or not is a little bit of a gray area. I'm actually trying to drill down on that here in the U.S., [25:54] It might be, it might not be. It's not... [25:56] entirely clear. It needs to be done in concert with a physician. It is a class 2 medical device. You need a prescription to use this. So you put it... [26:04] You've got a prescription from your local doctor to... [26:07] deliver them. Yeah, okay. And just ballpark, Jack, what sort of cost is it for these machines? If there's a doctor listening, a cardiologist listening wondering if they should be... Sure, yeah. So if you were to work with the manufacturers, you'd [26:23] probably pay somewhere in the neighborhood of $30,000 US to upwards of, you know, double or even possibly triple that, I suppose. [26:32] You can, you know, there is a resale market. So, [26:35] There's kind of a reason. There's some history. Some people invested in these and make them available for sale. So you can sometimes find some on the resale market. [26:46] for considerably less than that. [26:50] Yeah, so... [26:52] And tell me, the sessions that you do most days, Jack, and the session time you'd recommend for people, are we talking about? [26:58] 10 minutes, 20 minutes, half an hour, two hours. It's 12 minutes. [27:02] 35 hours is... [27:04] an hour at a time as the, you know, the standard protocol if you were treating angina to get to that 35-hour mark. And that's definitely what I did. And I kept going with one-hour sessions until I just started feeling better and better. You know, I like to think of myself at sort of a maintenance phase or something, you know, just keeping what I've created open by giving that [27:22] pressure throughput. So I just do 15 minutes in the morning because, again, I like it. It feels good. But, you know, I travel and I don't take it with me. So, you know, I go... [27:32] days. I just went several days without it. No problem. No dependency. Okay. Interesting. And you're obviously on all the appropriate... [27:42] standard health... [27:44] recommendation medications for heart attack, [27:48] Cholesterol, pressure, aspirin, et cetera, et cetera. So this is an add-on rather than looking at supporting best care. [28:00] Yeah, good. [28:01] Yeah, it's complementary to so many different other modalities that might be prescribed by a provider. Yeah, so many. [28:07] That's fascinating. Jack, it's been an absolute delight speaking with you. [28:12] Thank you so much for joining me. [28:15] Yeah, I appreciate you having me on. It's been great to get to talk with you, Dr. Ward. [28:19] For those listening, I'm pretty sure you will have learned [28:24] something about an area that really I haven't known too much about at all. We do know that in the acute setting, in the very sick patient setting, we can put balloons up into the aorta and those balloons up into the aorta expand and deflate in a counterpulsation way. So we do do [28:54] but to be honest I didn't know that it was as an outpatient basis. That's where the technology came from right? [29:03] Hey do you mind if I just mention to your listeners about my book in case there's any interest? Yeah sure. For anybody that's interested you can go to eecpbook.com and you know I've got a pre-launch site up with some information about the book and information about myself. We'll be getting the book out here and definitely by the end of May. [29:22] Fantastic. So one more time, that was eecpbook.com. Check it out if you're interested and maybe listen to this podcast again or watch this video again. Jack, thank you so much for those listening. I really, as always, really appreciate you taking the time because I know your time is valuable to have a listen and I really hope I've given you something worthwhile. [29:47] and interesting and informative. If you have any queries or questions, drop us a note. [29:53] Other than that, till next time, I hope you live as well as possible for as long as possible. [29:59] Take care and bye for now. [30:03] Did you know that coronary artery disease kills one in four people? So most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com.au. It'll give you information about risk. [30:26] And what else can be done to be even more precise?